BILL ANALYSIS
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THIRD READING
Bill No: SB 771
Author: Alquist (D)
Amended: 1/26/10
Vote: 21
SENATE HEALTH COMMITTEE : 6-1, 1/13/10
AYES: Strickland, Cedillo, Leno, Negrete McLeod, Pavley,
Romero
NOES: Cox
SENATE APPROPRIATIONS COMMITTEE : 6-3, 1/21/10
AYES: Kehoe, Corbett, Leno, Liu, Price, Yee
NOES: Cox, Denham, Walters
SUBJECT : Medi-Cal: continuous eligibility: semiannual
status reports
SOURCE : Author
DIGEST : This bill lengthens the period for which
Medi-Cal would allow 12-month continuous Medi-Cal
eligibility for children, in order for the state to qualify
for additional federal funds via a temporary increase in
the Federal Medical Assistance Percentage (FMAP),
contingent upon adoption of certain federal legislation,
and makes the reinstatement of 12-month continuous
eligibility effective only during the time period that the
increased FMAP is available.
ANALYSIS : Existing federal law:
CONTINUED
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1.Establishes the Medicaid program to provide comprehensive
health benefits to low-income persons.
2.Allows states to provide continuous eligibility for
children in Medicaid, which means that the eligibility
determinations are for a set period, regardless of
changes in the income and resources of applicants. (The
federal American Recovery and Reinvestment Act of 2009
(ARRA), provides an increase in FMAP, retroactively from
October 2008 until December 31, 2010, to qualifying
states.)
3.Provides that the increased FMAP is available for state
Medicaid, foster care and adoption assistance programs.
4.Requires that states, to be eligible for the increased
FMAP, may not have more restrictive eligibility
standards, methodologies or procedures in place than
those that were in effect as of July 1, 2008.
Existing state law:
1.Establishes the Medi-Cal program as California's Medicaid
program, administered by the Department of Health Care
Services (DHCS), which provides comprehensive health care
coverage for certain low-income individuals and their
families; pregnant women; elderly, blind, or disabled
persons; nursing home residents; and refugees who meet
specified eligibility criteria.
2.Requires most Medi-Cal enrollees to file semi-annual
status reports to maintain Medi-Cal enrollment.
3.Existing law establishes 12 months of continuous
eligibility in Medi-Cal for children. Limits the period
of 12-month continuous eligibility to the period that
increased federal financial participation is available
through Medicaid under ARRA.
4.Provides that 12 months of continuous eligibility is
inoperative when the Director of the DHCS executes a
declaration specifying that increased federal financial
participation is no longer available under ARRA.
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5.Provides that upon the execution of the declaration, a
6-month period of continuous eligibility will be used for
children in Medi-Cal, with a required semi annual report.
6.Provides that the 6-month period of continuous
eligibility expires on July 1, 2012, after which a
12-month period of continuous eligibility is reinstated.
This bill provides that the 12-month period of continuous
eligibility for Medi-Cal for children will become
inoperative when the Director of DHCS executes a
declaration specifying that increased federal financial
participation is no longer available under ARRA, or any
subsequent federal legislation, including an amendment to
ARRA, which maintains or extends increased federal
financial participation for two calendar quarters.
Background
Title V of the ARRA increased the federal share of Medicaid
(Medi-Cal in California) program costs by increasing the
FMAP for 27 months (October 1, 2008 through December 2010).
The FMAP increase applies only if a state conformed to
certain specified requirements as contained in ARRA. One
of the key federal requirements is that states may not have
eligibility standards, methodologies or procedures in place
that are more restrictive than those that were in effect as
of July 1, 2008. Any state that implemented more
restrictive policies after July 1, 2008 had until July 1,
2009 to rescind them. The state would then be fully
eligible for the enhanced match, retroactive to October 1,
2008.
ARRA provides several different formulas for increasing
FMAP. Using the applicable formula, California received an
increase in FMAP of 11.59 percentage points from ARRA,
which provides for a 61.59 percent FMAP for Medi-Cal as
opposed to the customary 50 percent. This enhanced FMAP
provides California with approximately $10 billion in
additional federal funds for the 27-month period.
The state was at risk of not being eligible for the
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increased FMAP because it had changed from 12-month
continuous eligibility to 6 months, with required
semi-annual reporting, for children enrolled in Medi-Cal.
This amendment was contained in AB 1183, Statutes of 2008
(Omnibus Health Trailer Bill), which was enacted after July
1, 2008 and was considered to be a more restrictive
eligibility standard, methodology or procedure under
federal law. SBX3 24 temporarily reinstated 12-month
continuous eligibility to comply with the federal
requirement.
Congress is currently deliberating the Jobs for Main Street
Act (HR 2847). This legislation will extend the increased
FMAPs established in ARRA. Estimates are that California
will obtain an additional $2.5 billion if the act is
enacted.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
Fiscal Impact (in thousands)
Major Provisions 2010-11
2011-12 2012-13 Fund
Continuation of 12-month $2,400 $40,000-92,000 $0
General*
Continuous Medi-Cal eligibility $2,400 $40,000-92,000
$0 Federal*
for children
*Assumes Medi-Cal costs are shared 50% General Fund and 50%
federal funds and that the enhanced FMAP is extended
through 7/1/12.
SUPPORT : (Verified 1/25/10)
100% Campaign, a collaborative of Children Now, Children's
Defense
Fund, The Children's Partnership and PICO California
California Association of Health Plans
California Communities United Institute
California Medical Association
California Mental Health Directors Association
California State Association of Counties
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County Health Executives Association
County Welfare Directors Association
Health Access California
Regional Council of Rural Counties
Urban Counties Caucus
Western Center on Law and Poverty
ARGUMENTS IN SUPPORT : Supporters state this bill will
allow California to participate in the proposed extension
of the enhanced FMAP and allow counties and public
hospitals to receive funds for Medi-Cal, foster care and
adoption assistance programs, by assuring that the state
complies with federal requirements regarding eligibility
for Medicaid services. They argue that these funds are
critical to counties for the operation of desperately
needed health and human services programs, particularly in
light of the unprecedented demands for services that
counties are seeing due to the economic crisis. They state
that without the increased FMAP funding, these critical
safety net programs are in jeopardy. The 100% Campaign
points out those requiring children to reapply every six
months, instead of annually buries them in paperwork so
those who cannot keep up are dropped from coverage.
CTW:nl 1/26/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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